MEASURING WORKPLACE STRESS

May 7, 2015

Occupational Health Clinics for Ontario Workers Inc.

John Oudyk

ESDC Open House 2015

Occupational Health Clinics for Ontario Workers (OHCOW)

§ an inter-disciplinary occupational health team:  occupational physicians  occupational health nurses  ergonomists  occupational hygienists  client services co-ordinators

§ funded though the Ministry of Labour (& WSIB)

§ Board of Directors are labour representatives

Clinic Services:

1. individual client (clinical)

2. answer questions (work/health related)

3. informational presentations

4. workplace visitsØ requested by co-chairs of JH&SC

5. exposure/health investigationsØ medical/hygiene/ergonomic combined

What’s a chemical engineer doing measuring stress?

§ Assistant professor (part-time) in Clinical Epidemiology and Biostatistics Dept. (McMaster U)

§ Plastimet fire Firefighter survey (1997)ú obvious from symptom survey that stress was an important

reaction to the fireú in follow-up surveillance program asked about stress related

incidents (PTSD?) – developed customized scale from these reports

§ Indoor Air Quality investigations (1991)ú Survey instrument used had 4 brief questions on stressú Later (2000) added a short version of Karasek’s JCQ (14

questions)

Economic burden: ú “10 to 25% of Canadian workplaces effectively

mentally injurious – not good for the mental health of their employees” … “leading cause of short-term disability and long tern disability – it’s the biggest single reason people are off work for periods of time”

ú “estimated at $51‐billion” … “ up substantially over the past decade”

Speech of the Honourable Michael Kirby

A workplace issue

http://www.youtube.com/watch?v=5qfTFxOc6Xo&feature=player_embedded

WHSC, Occupational Health & Safety: A Training Manual 1982

The Stress Reaction

HPA - Axis

§ Hypothalamic–pituitary–adrenal (HPA) axis: three endocrine glands that represent the mind-body connection

§ Allostatic load is the physiological consequences of stress hormones on the body (cortisol, epinephrine, norepinephrine, etc.)

§ Biomarkers include neuroendocrine (cortisol), immune markers, metabolic (cholesterol), cardiovascular (blood pressure, HRV), respiratory (peak flow), anthropometric (BMI)

Mayo Clinic: “Chronic stress puts your health at risk”“The long-term activation of the stress-response system — and the subsequent overexposure to cortisol and other stress hormones — can disrupt almost all your body's processes. This puts you at increased risk of numerous health problems, including:

§ Anxiety§ Depression§ Digestive problems§ Heart disease§ Sleep problems§ Weight gain§ Memory and concentration impairment”

http://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037?pg=1

http://www.statcan.gc.ca/pub/11-008-x/2011002/article/11562-eng.pdf

“What’s stressing the stressed?Main sources of stress amongworkers”by Susan Crompton (Stats Can) 2011 “In Canada, in 2010, 27% of

working adults reported that, on most days, their lives were ‘quite’ or ‘extremely stressful.”

Dr. David Posen, Is Work Killing You?: A Doctor's Prescription for Treating Workplace Stress, House of AnansiPress, Toronto (2013)

Is Work Killing You?

“There are two ways to reduce the stress. One is to get rid of what's there. Exercise, meditation, relaxation, a massage, medication such as tranquillizers, diversion and distraction, humour, laughter, and play can all be helpful. However, if you don't eliminate the source of stress (overwhelming workload, unrealistic deadlines, a difficult boss), you can jog and eat broccoli till the cows come home and you won't get ahead of the problem. The stress will keep accumulating as fast as you can dissipate it.

The best way to deal with stress is to get rid of what's there and eliminate the source.” (page 291)

Dr. David Posen, Is Work Killing You?: A Doctor's Prescription for Treating Workplace Stress, House of Anansi Press, Toronto (2013)

Is Work Killing You?

“The first book ran the risk of being seen as blaming the victim, although, fortunately, no one took it that way. This book runs the risk of blaming the organization for all the stress. The truth is somewhere in the middle. It's a shared responsibility, but I have observed that an increasing amount of the stress in recent years has been company-driven and organizations are doing precious little to own up to the damage they're causing on a daily basis.” (page 321)

Dr. David Posen, Is Work Killing You?: A Doctor's Prescription for Treating Workplace Stress, House of Anansi Press, Toronto (2013)

the new CSA Standard Z1003-13

http://shop.csa.ca/en/canada/occupational-health-and-safety-management/cancsa-z1003-13bnq-9700-8032013/invt/z10032013/?utm_source=redirect&utm_medium=vanity&utm_content=folder&utm_campaign=z1003

Psychological& social support

Growth and development

Engagement

Psychological demands

Protection of physical safety

Workload management

Civility and respect

Psychologicalprotection

Involvement and influence

Clear leadership & expectations

Balance

Recognition and reward

Organizational culture

Vision A workplace that promotes workers’ psychological well-being and allows no harm to workers mental health...

Key Drivers

Risk Management Excellence & sustainabilityRecruitment & RetentionCost Effectiveness

Strategic pillars

Prevention (1°) Promotion (2°) Resolution (3°)

Mary Deacon, Chair, Bell Mental Health Initiative (Oct 24/13*)

§ A lot of organizations have the attitude that they can’t go down this road because it leaves the organization vulnerable to criticism.

§ They have to accept that this is a journey – need to admit the organization is not perfect – we will make progress but also will make mistakes & learn.

* Rotman School of Business - 7th Annual Mental Health in the Workplace Forum (Oct 24/2013)

Tracking [Weathering] the Perfect Legal Storm (Shain, 2010, [2014])

§ Labour relations law§ Employment standards§ Human rights legislation§ Law of torts (negligence)§ OH&S law (violence & harassment)§ Workers’ compensation changes (BC)§ Awards up 700% over that last 5 years

… recent opinion (22/10/2013) that CSA standard sets the legal criteria for a psychologically safe system of work

http://www.mentalhealthcommission.ca/English/node/506?terminitial=30

soooooo….How would you go about measuring stress?

If you can’t measure it …

§ Misquote from Deming

§ Some of the most important things at work (in life) can’t be measured (e.g. Valentine’s)

§ Objective and Subjective measures: objective bias (more scientific)

Stress Check App (Azumio)(measures heart rate variability)

https://itunes.apple.com/us/app/stress-check-pro-by-azumio/id439500612?mt=8https://play.google.com/store/apps/details?id=com.azumio.android.stresscheck&hl=en

Measurements over a 40 hr period

17%16%18%

31%24%

38%

2%1%

37%

55%60%

48%45%49%

43%

20%27%

17%

50%

97%

77%

62%58%

42%

7%

90%

67%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%4:

00 P

M5:

30 P

M7:

00 P

M8:

30 P

M10

:00

PM11

:30

PM1:

00 A

M2:

30 A

M4:

00 A

M5:

30 A

M7:

00 A

M8:

30 A

M10

:00

AM11

:30

AM1:

00 P

M2:

30 P

M4:

00 P

M5:

30 P

M7:

00 P

M8:

30 P

M10

:00

PM11

:30

PM1:

00 A

M2:

30 A

M4:

00 A

M5:

30 A

M7:

00 A

M

HR

V (

in %

)

time

work

work

work

bedt

ime

wat

chin

g a

scar

y m

ovie

bef

ore

bedt

ime

com

mut

e

com

mut

e –

traf

fic ja

m

roller bladingat lunchtime

supp

er &

dis

hes

wak

e-up

: rar

in’ t

o go

!

supp

er

woken up by job offer call

Psychological “Subjective” Measures:§ Remember, perceptions/symptoms

are the “gold standard” (DSM-V)

§ Diagnoses made on the basis of answers to a series of questions (some of which are observable by others; some not)

§ Some questions don’t work directly (… are you depressed?) and thus need to be questioned indirectly

http://www.dsm5.org/Pages/Default.aspx

DSM-5: Depression screening(individual)

1. Little interest or pleasure in doing things 2. Feeling down, depressed, or hopeless 3. Trouble falling or staying asleep, or sleeping too much 4. Feeling tired or having little energy 5. Poor appetite or overeating 6. Feeling bad about yourself—or that you are a failure or have let yourself or

your family down 7. Trouble concentrating on things, such as reading the newspaper or

watching television 8. Moving or speaking so slowly that other people could have noticed? Or

the opposite—being so fidgety or restless that you have been moving around a lot more than usual

9. Thoughts that you would be better off dead or of hurting yourself in some way

http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Level2DepressionAdult.pdf

Mental Injuries Tool (MIT) Group:§ The Mental Injuries Tool group was established

in 2009 out of a stakeholder sub-committee of worker representatives and the Occupational Health Clinics for Ontario Workers who were charged with “supporting worker representatives in taking action on prevention and workers’ compensation”.

§ This sub-committee held a workshop in 2010 to select projects which could be developed jointly to address common concerns. The topic which received the most interest was mental injuries(workplace psychosocial risk factors; recognition & compensation for mental injuries).

MIT group - who’s involved:§ Laura Lozanski, CAUT§ Terri Aversa, OPSEU§ Sari Sairanen, UNIFOR§ David Chezzi, Andréane Chénier, CUPE § Nancy Johnson, Erna Bujna, ONA§ Valence Young, ETFO§ Gerry LeBlanc, Sylvia Boyce, USW§ Chris Watson, Mary Shaw , UFCW 175/633§ Jane Ste. Marie, John Watson, OSSTF§ Kathy Yamich, Workers United Union§ Charlene Theodore, OECTA § Sophia Berolo, University of Waterloo§ Ashley McCulloch, Carleton University§ Andy King, LOARC (Labour, OHCOW, Academic Research Collaboration)§ Maryth Yachnin, IAVGO§ Alec Farquhar, Kristen Lindsay, OWA§ Curtis VanderGriendt, Ted Haines, Mark Parent, Andre Gauvin, Brenda

Mallat, Valerie Wolfe, John Oudyk (OHCOW)

Prevention

individual organization

prev

entio

nle

vel primary - coping and

appraisal skillsprimary -

secondary - wellness, relaxation techniques

(mindfulness)

secondary -awareness, screening

(surveys)tertiary - therapy,

counselling, medication, support

tertiary - Employee Assistance Programs (EAP), Return to Work

MIT tools

Psychology

Focus on what’s going on between the ears

Psychosocial

Focus on the interaction between the social environment and the person

Differing Perspectives:

MIT Tools:

§ Website http://www/ohcow.on.ca/MIT§ Guide§ Survey (often use Survey Monkey)§ You-Tube videos§ Posters, cards§ App http://www.ohcow.on.ca/MITApp§ [training materials]§ [mini-MIT shortened guide for

workplaces]

COPSOQ

Copenhagen Psychosocial Questionnaire

(COPSOQ II – short version)

http://www.arbejdsmiljoforskning.dk/Sp%C3%B8rgeskemaer/Psykisk%20arbejdsmilj%C3%B8.aspx?lang=en

COPSOQ Psychosocial Hazards:

… now for something completely different …

§ In partnership with the CCOHS, we’ve created an app that allows you to do the survey and have your own personal score

http://www.ohcow.on.ca/MITApp

How do we do it?

1. Recruit a coordinator/champion in each unit (knowledgeable on workplace stress)

2. Get buy-in (union, employer, establish steering committee)

3. Administer survey (define units, collect e-mail lists, Dilman’s 5 contact survey administration, spreadsheet report production, identify top 3 issues)

4. Begin dialogue to improve top 3 issues

Don Dilman’s approach to maximizing survey response:

1) Lay the groundwork – get endorsements/buy-in; set up steering committee; define relationships to JH&SC, union, employer involvement; sort out logistics (electronic or paper, who’s in charge of what, confidentiality, data management/security, when do we report results, what do we do next – long term objectives)

2) Pre-survey announcement (1-2 weeks prior) with endorsements

3) Distribute survey – fanfare?; provide time, space, incentives?

4) 1-2 weeks later send out reminder

5) After another 1-2 weeks send a 2nd reminder. Ø if response rate is poor (<66%) you may have to consider a stronger intervention

(i.e. start “nagging” people directly)

6) After a reasonable period of time (and depending on response rate) set a closing date and send out a final notice with an urgent message.

Collecting responses

§ Send URL link to participants who fill out survey online (5-15 minutes)§ Response confidential; downloaded by

Clinic

Report:

Finding solutions to your problems …

§ List the top risk factors associated with symptoms

§ Refer to resources (plenty online) and don’t be afraid to ask for help

§ Best not to work alone but with a representative steering committee

§ “let the conversation begin …”

MHCC

PH&S – An Action Guide for Employers

http://www.mentalhealthcommission.ca/English/node/505

International Labour Organization (ILO) Stress Prevention Guidebook:

§ checkpoint format § lists specific hazards§ identifies prevention strategies

http://www.ilo.org/global/publications/books/forthcoming-publications/WCMS_168053/lang--en/index.htm

ILO Checkpoint exampleCHECKPOINT 6§ Adjust the total workload (quantitative demands)

taking into account the number and capacity of workers.

HOW1. Assess individual and team workloads through

observation and discussion with workers to determine whether change is necessary and feasible.

2. Reduce unnecessary tasks such as control operations, writing reports, filling in forms or registration work.

3. …

e.g. Hospital Guidance tool

§ High emotional demands prevention activities:ú Feedback, coaching and acknowledgement from

colleagues and managersú Specific objectives for work (when is the work

result good enough/success criteria?)ú Consensus and practice with regard to care and

treatment ú Overlap/transfer for shift changesú Possibility of withdrawing (a place for privacy)

extracted from: http://www.av.se/dokument/inenglish/European_Work/Slic%202012/English_7.pdf

Mental Health First Aid:

http://www.mentalhealthfirstaid.ca/EN/resources/Pages/MHFAGuidelines.aspx

e.g. “What is a panic attack?”§ “A panic attack is a distinct episode of high anxiety, with

fear or discomfort, which develops abruptly and has its peak within 10 minutes. During the attack, several of the following symptoms are present.ú Palpitations, pounding heart, or rapid heart rateú Sweatingú Trembling and shakingú Shortness of breath, sensations of choking or smotheringú Chest pain or discomfortú Abdominal distress or nauseaú Dizziness, light-headedness, feeling faint or unsteadyú Feelings of unreality (derealisation), or being detached from oneselfú Fears of losing control or going crazyú Fear of dyingú Numbness or tinglingú Chills or hot flushes”

http://www.mentalhealthfirstaid.ca/EN/resources/Documents/MHFA_panic_guidelines.pdf

“PANIC ATTACKS:FIRST AID GUIDELINES”

§ What should I do if I think someone is having a panic attack?

§ What if I am uncertain whether the person is really having a panic attack, and not something more serious like a heart attack?

§ What should I say and do if I know the person is having a panic attack?

§ What should I say and do when the panic attack has ended?

http://www.mentalhealthfirstaid.ca/EN/resources/Documents/MHFA_panic_guidelines.pdf

ALGEE - five-step action plan

A - Assess for risk of suicide or harm L - Listen nonjudgmentally G - Give reassurance and information E - Encourage appropriate professional help E - Encourage self-help and other support strategies

http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=321http://mhfa.com.au/cms/guidelines

Laval Business group (business case)

http://www.cgsst.com/eng/publications-sante-psychologique-travail/trousse-la-sante-psychologique-au-travail.asp

§ Pre-contemplation (Not Ready) – “what problem? That’s just the way things are in this line of work – always has been, always will.”

§ Contemplation (Getting Ready) – “maybe things could change but I don’t know if I’m prepared to change? It is easier though, just going along with things the way they are, but maybe …??”

§ Preparation (Ready) – “things could be better and I think it’s worth the effort to try – let’s get together and figure out how to do something about this …”

§ Action – “we’re going to make the following changes and hope things will improve – I’m glad we’re finally doing something about this!”

§ Maintenance – “so, we’ve made the changes, they might need a bit of tweaking, but I think this is going to work out in the long run”

Are You Ready to Do It?Stages of Change

Drivers (sticks and carrots):

1. Costs ($51 Billion)2. Risk (do you want to read about your

workplace in the newspaper?)3. Legal liability (Martin Shain’s work)4. Worker retention and recruitment (good

place to work)5. Excellence and sustainability (Wellness)6. The right thing to do – “law is the

conscience of those who have none” (James Ham, 1983 IAPA Conference)

What can you do?

Taking Action on Workplace Stress

Occupational Health Clinics for Ontario Workers Inc.

John Oudyk, Occupational HygienistOccupational Health Clinics for Ontario Workers (OHCOW)

http://www.ccohs.ca/products/webinars/workplace_stress/

Thank you!